BOSNIAN JOURNAL OF BASIC MEDICAL SCIENCES 2009; 9 (3): 210-214&
Abstract
Prosthodontic rehabilitation can be accomplished with fi xed, overdenture, complete, or implant-retained prostheses. Dental treatment overcomes the patient’s functional, psychological, esthetic and phonation problems. Remaining healthy teeth may allow the dentist to fabricate a removable partial overdenture, fi xed partial prosthesis or implant – supported prosthesis. Th e retention of a number of abutments helps maintain a positive ridge form with greater height and volume of the alveolar bone, improving masticatory performance, as well as providing a more stable prostheses. Dental patients who have medical problems need many treatment procedures. Multidisciplinary treatment planning is invaluable for patient’s dental health. Progeria is a rare genetic condition where symptoms resembling aspects of aging are manifested at an early age. characteristic clinical fi ndings of Progeria disease include abnormalities of the skin and hair in conjunction with char-acteristic facial features and skeletal abnormalities. Th e characteristic facies show protruding ears, beaked nose, thin lips with centrofacial cyanosis, prominent eyes, frontal and parietal bossing with pseudohydrocephaly, midface hypoplasia with micrognathia and large anterior fontanel. Th e other reported anomalies are dystrophic nails, hypertrophic scars and hypoplastic nipples. Th e fi ndings that are nearly interested in dentistry are delayed dentition, anodontia, hypodontia, or crowding of teeth. Th is article presents the multidisciplinary dental treatment planning includes surgical, endodontic and prosthetic treatment of a patient with a history of progeria. In this case complete-arch fi xed prostheses in both maxilla and mandible, supported by a combination of im-plants and teeth are reported.
KEY WORDS: Implant supported fi xed partial prosthesis, partial edentulism, progeria, multidis-ciplinary treatment
IMPLANT SUPPORTED
PROSTHESIS IN A PATIENT
WITH PROGERIA:
CASE REPORT
Gözlem Ceylan¹, Nergiz Yılmaz², Özgün Şenyurt², Göknil Ergün Kunt¹*
¹ Department of Prosthodontics, Dental Faculty of Ondokuz
Mayıs University, , Samsun, Turkey
² Department of Oral and Maxillofacial Surgery, Dental Faculty of Ondokuz
BOSNIAN JOURNAL OF BASIC MEDICAL SCIENCES 2009; 9 (3): 211-214
Introduction
Partial or total edentulism results in some loss of func-tion, such as chewing and eff ects esthetics. Prosthodon-tic rehabilitation of a patient can be accomplished with fi xed, overdenture, complete, or implant-retained prostheses. For rehabilitation, it is crucial to know the age, number and condition of present teeth. Dental treatment may assist patients in overcoming func-tional, psychological, esthetic and phonation problems. In patients the remaining healthy teeth may allow the dentist to fabricate removable partial overdenture, fixed partial prosthesis or implant – supported pros-thesis (). Fixed partial prospros-thesis derives support from the remaining healthy teeth. The retention of a number of abutments helps maintain a positive ridge form with greater height and volume of the alveolar bone, improving masticatory performance, as well as providing a more stable prostheses. Th e restoration of partially edentulous patients with implant represents a major challenge for the clinician. Sometimes the treat-ment plan has to be adapted to the patient’s demands. Progeria, a hereditary disease, eff ects the skin, musculo-skeletal system, and vasculature. Progeria shows an ac-celerated ageing combined with severe growth retarda-tion. As newborns, children with progeria usually appear normal. However, within the fi rst years of life, their growth rate slows and they soon are much shorter and weigh much less than others their age. Th e disease be-gins at age - months, when skin changes and alopecia are fi rst noted and when the infant fails to gain weight. Some children with progeria have undergone coronary artery bypass surgery and/or angioplasty in attempts to ease the life-threatening cardiovascular complica-tions caused by progressive atherosclerosis. However, there currently is no treatment or cure for the underly-ing condition. Th e average life expectancy for a patient with progeria is years with an age range of - years. Th e mortality of the patient is usually from heart attack or stroke, Th e prevalance of progeria is reported of in million births. Especially white persons represent of reported patients. Th e disease has a slight male predilection; the male-to-female ratio is .: (,,). Patient with progeria has the following other sugges-tive fi ndings which are high-pitched voice, short stat-ure and low weight for height, with prenatal onset of growth failure, incomplete sexual maturation, general-ized osteoporosis and pathologic fractures, feeding dif-fi culties and low-frequency conductive hearing loss (). Th e characteristic clinical fi ndings of Progeria disease
include abnormalities of the skin and hair in conjunc-tion with characteristic facial features and skeletal abnormalities. Th e characteristic facies show protrud-ing ears, beaked nose, thin lips with centrofacial cy-anosis, prominent eyes, frontal and parietal bossing with pseudohydrocephaly, midface hypoplasia with micrognathia and large anterior fontanel. The other reported anomalies are dystrophic nails, hypertro-phic scars and hypoplastic nipples (). The findings that are nearly interested in dentistry are delayed den-tition, anodontia, hypodontia, or crowding of teeth. A -year-old female patient who visited our clinic and
diagnosed with progeria was treated by a multi-disci-plinary team of surgeons, endodontist, and prosthodon-tists. A teeth retained fi xed partial denture in the maxilla and an implant-teeth supported fi xed partial denture in the mandible were planned. Th is article presents the prosthodontic rehabilitation of the patient with progeria.
Case Report
fon-
BOSNIAN JOURNAL OF BASIC MEDICAL SCIENCES 2009; 9 (3): 212-214tanel were observed. The patient’s detailed intraoral examination was made. Periodontal condition and soft-tissue examination showed that there were pocket depths over mm and mobility in many of the remain-ing teeth especially in the mandibular arch. Signed con-sent form was obtained from the patient for the dental treatment. Her panoramic radiograph was evaluated (Figure ). Radiographically there were also bone re-sorptions. Th e teeth which were contreindicated for the construction of the prosthesis (, , , , , , , , , , ) were extracted by a surgeon due to mal-position and mobility. Maxillary , and were en-dodontically treated. Maxillary third molar () was not included to the prosthesis plan. For the patient, the ad-vantages of retaining the remaining teeth for retention, stability, function and the phonetics of the denture, as well as proprioception, were considered. A diagnostic cast was prepared and the denture was planned. Since the patient’s age was young, she did not prefer to have removable partial dentures. So we decided to apply teeth retained fixed prosthesis in the maxilla and im-plant -teeth supported fi xed prosthesis in the mandible.
BOSNIAN JOURNAL OF BASIC MEDICAL SCIENCES 2009; 9 (3): 213-214
the fi xed partial prosthesis. She stated that she was able to speak and function better. Her facial appearance was improved. Th e patient has been using her prostheses for six months and has not presented any complaints.
Discussion
Removable partial prosthesis are still extensively used for the restoration of partially edentulous patients. However, these prostheses have been associated with poor patient acceptance, compromised function and esthetics, and increased risk for caries and periodontal disease (, -). Implant-supported prosthesis offers a predictable treatment for tooth replacement (-). Th e clinical outcome of complete-arch fi xed prostheses supported by implants and natural tooth in patients with normal or reduced periodontal support has been reported by few studies, with controversial results (,). Th e range of implant indications has beeen significantly widened and partially dentate patients represent the majority of patients who need treatment with dental implants today. Implant therapy has become common practice and will probably gain in popularity during the next several years. Implant surgery must be per-formed to satisfy prosthodontic need and indications. Both surgical and prosthodontic phases of treatment require careful pretreatment diagnosis, evaluation and planning. Th e individual number and distribution of implants is influenced by following factors; bone quality-quantity, arch size- shape, interarch distance, opposing dentitions, intraoral and extraoral esthetics, need for hygen access and implant inclination. When complete-arch fixed prostheses, supported by a com-bination of implants and teeth, were fabricated for pa-tients they improve the quality of life for the patient. In patients the remaining teeth for retention, stabil-ity, function and the phonetics of the denture, as well
BOSNIAN JOURNAL OF BASIC MEDICAL SCIENCES 2009; 9 (3): 214-214Conclusion
In such cases, removable partial prosthesis and implant supported fi xed prosthesis are alternative dental treatments. Im-plant supported fi xed prosthesis were suggested to the patient and she is happy with her dentures.
References
() Vermeulen A.H., Keltjens H.M., van’t Hof M.A., Kayser A.F. Ten-year evaluation of removable partial dentures: survival rates based on retreatment, not wearing and replacement. J. Prosthet. Dent. ;:-.
() Badame A.J. Progeria. Arch. Dermatol. ;():-.
() Gordon L.B., McCarten K.M., Giobbie-Hurder A., Machan J.T., Campbell S.E., Berns S.D.,Kieran M.W. Disease progression in Hutchinson-Gilford progeria syndrome: impact on growth and development. Pediatrics. ;():-.
() Hennekam R.C. Hutchinson-Gilford progeria syndrome: review of the phenotype. Am J Med Genet A. ;():-.
() Merideth M.A., Gordon L.B., Clauss S., Sachdev V., Smith A.C., Perry M.B., Brewer C.C., Zalewski C., Kim H.J., Solomon B., Brooks B.P., Gerber L.H., Turner M.L., Domingo D.L., Hart T.C., Graf J., Reynolds J.C., Gropman A., Yanovski J.A., Gerhard-Her-man M., Collins F.S., Nabel E.G., Cannon R.O. rd, Gahl W.A., In-trone W.J. Phenotype and course of Hutchinson-Gilford progeria syndrome. N. Engl. J. Med. ;(): -.
() Paradisi M., McClintock D., Boguslavsky R.L., Pedicelli C., Wor-man H.J., Djabali K. Dermal fi broblasts in Hutchinson-Gilford progeria syndrome with the lamin A GG mutation have dys-morphic nuclei and are hypersensitive to heat stress. BMC Cell Biol. ;:.
() Douglass C.W., Watson A.J. Future needs for fi xed and remov-able partial dentures in the United States. J. Prosthet. Dent. ;:-.
() Liedberg B., Stoltze K., Owall B. The masticatory handicap of wearing removable dentures in elderly men. Gerodontology. ;:-.
() Zlataric D.K., Celebic A., Valentic-Peruzovic M. Th e eff ect of re-movable partial dentures on periodontal health of abutment and non-abutment teeth. J. Periodontol. ;:-.
() Esposito M., Grusovin M.G., Coulthard P., Th omsen P., Wor-thington H.V. A -year follow-up comparative analysis of the efficacy of various osseointegrated dental implant systems: a systematic review of randomized controlled clinical trials. Int. J. Oral. Maxillofac. Implants. ; :-.
() Norton M.R. Biologic and mechanical stability of single tooth implants: - to -year follow-up. Clin Implant Dent Relat Res. ;:-.
() Levin L., Laviv A., Schwartz-Arad D. Long-term success of im-plants replacing a single molar. J Periodontol. ;():-.
() Levin L., Pathael S., Dolev E., Schwartz-Arad D. Aesthetic versus surgical success of single dental implants: - to -year follow-up. Pract. Proced. Aesthet. Dent. ;:-.
() Levin L., Sadet P., Grossmann Y. A retrospective evaluation of single-tooth implants: A six-year follow up. J. Periodontol. ;: -.
() Mayer T.M., Hawley C.E., Gunsolley J.C., Feldman S. Th e single-tooth implant: A viable alternative for single single-tooth replacement. J. Periodontol. ;:-.
() Gallucci G.O., Doughtie C.B., Hwang J.W., Fiorellini J.P., Weber H.P. Five-year results of fi xed implant-supported rehabilitations with distal cantilevers for the edentulous mandible. Clin. Oral. Implants Res. ;:-.
